Rare Site Hepatocellular Carcinoma Metastasis

Abstract

Enrique Boldo,1 Ana Santafe,1 Araceli Mayol,1 Rafael Lozoya,1 Alba Coret,1 Diana Escribano,1 Carlos Fortea-Sanchis,1 Andres Muñoz,1 Juan Carlos Pastor,1 Guillermo Perez de Lucia,1 Nuria Bosch2 1Department of Surgery, Consorcio Hospitalario Provincial de Castellon, Castellon, Spain; 2Pathology Department, Consorcio Hospitalario Provincial de Castellon, Castellon, SpainCorrespondence: Enrique BoldoServicio de Cirugia, Consorcio Hospitalario Provincial de Castellon, Avenida Dr Clara 19, Castellon 12002 Tel [phone]Fax [phone]Email [email protected]: Besides more common sites such as lung or peritoneum, hepatocellular carcinoma (HCC) can metastatize to rare sites. We report herein a new metastatic site of HCC: the nail-bed. We also review other recently reported rare site HCC metastases (RSHM).Case Report: A 66-year-old woman with a 12-year history of resected-stage IA HCC who later presented lung, spleen and brain metastases treated with surgery, systemic therapies (sorafenib, sunitinib, capecitabine) and radiotherapy. The patient was referred to us because of a painful and rapidly evolving mass in the nail-bed of the left thumb. Biopsy confirmed nail-bed HCC metastasis, and the finger was amputated. The patient died few weeks later.Conclusion: This case was an opportunity for us to review RSHM. This type of metastasis seems to be an early event, in the context of advanced stage HCC with elevated protein induced by vitamin K absence-II (PIVKA II). The Lee nomogram is useful in detecting patients at high risk of developing RSHM. We would suggest insisting on systemic treatment in these metastatic patients although overall survival after RSHM diagnosis is poor.Keywords: hepatocellular carcinoma, rare metastasis, surgery, PIVKA II, systemic treatment, nomogram

Keywords

• hepatocellular carcinoma. rare metastasis. surgery. pivka ii. systemic treatment. nomogram.